Summary & Overview
CPT 87103: Blood Culture, Fungal Identification to Genus Level
CPT code 87103 covers laboratory processing and identification of fungi isolated from blood cultures to the least specific taxonomic level, such as genus. This code captures a critical diagnostic step for suspected fungemia and invasive fungal infections, informing clinical management, antimicrobial stewardship, and hospital infection surveillance nationwide. Accurate coding of fungal culture and identification impacts reporting, laboratory workflow, and claims adjudication across public and private payers.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service represented by the code, typical sites of service, and payer coverage context. The publication summarizes typical use cases for fungemia diagnosis, outlines common billing modifiers and operational considerations (data not available in the input for specific payer rates), and highlights where CPT code 87103 fits within laboratory service lines.
This brief provides national-level context useful for coding managers, laboratory directors, and billing professionals seeking clarity on when CPT code 87103 applies, how it aligns with microbiology workflows, and what topics to review when reconciling laboratory claims and clinical documentation.
Billing Code Overview
CPT code 87103 describes a laboratory procedure in which a lab analyst performs a culture from a blood specimen and identifies any isolated fungus to the least specific level, such as genus. This is a microbiology identification service focused on detecting and reporting fungal organisms recovered from blood cultures.
Service Type: Laboratory — Microbiology, Fungal Culture and Identification
Typical Site of Service: Clinical laboratory or hospital laboratory setting where blood cultures are processed and microbial identification is performed. If specimens are collected in other clinical locations, processing and identification occur in a laboratory environment.
Clinical & Coding Specifications
Clinical Context
A 62-year-old hospitalized patient with persistent fever, hypotension, and altered mental status is undergoing evaluation for possible bloodstream infection. Blood cultures have been drawn per sepsis protocol; one set grows yeast-like organisms on routine culture. The clinical laboratory performs a fungal culture from the positive blood specimen and proceeds with identification to the least specific level, such as genus, using morphological assessment and rapid biochemical or MALDI-TOF methods. Results are reported to the treating team to guide antifungal therapy adjustment and infection control measures. Typical site of service is the hospital clinical microbiology laboratory; specimens are collected from the inpatient ward or intensive care unit and transported to the central laboratory. Specimen handling, incubation, subculture, and organism identification are the major workflow steps tied to 87103 billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting the professional interpretation or identification provided by the laboratory director or pathologist separate from technical testing. |
59 |